Jody B Herschenhorn-Dominick, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5247 Issued in AZ

Practice address

483 W. Seed Farm Rd.
Sacaton, AZ 85147-0038

Phone

(602) 528-1200

Fax

(602) 528-1296

NPI assigned

Oct 31, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gila River Health Care Corporation

  • Critical Access Hospital
  • Laveen, AZ
  • NPI 1376538231

  TX

  Medicare reassignment NPD
• Gila River Health Care

  • Community/Behavioral Health Agency
  • Laveen, AZ
  • NPI 1598021495
  NPD
• Gila River Health Care Corporation

  • Rural Acute Care Hospital
  • Maricopa, AZ
  • NPI 1386633915
  NPD
• Gila River Health Care Corporation

  • Community/Behavioral Health Agency
  • Chandler, AZ
  • NPI 1821599424
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331164800000",
    "number": "1770669939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38",
            "address_2": "GILA RIVER HEALTH CARE CORPORATION",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "851470038",
            "telephone_number": "602-528-1200",
            "fax_number": "602-528-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 W. SEED FARM RD.",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "851470038",
            "telephone_number": "602-528-1200",
            "fax_number": "602-528-1296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERSCHENHORN-DOMINICK",
        "first_name": "JODY",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2012-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "AZ0479240",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA DENTAL",
            "identifier": "873865",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "771768",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Juli Marge Haws, RD
• Kevin Lynn Helmuth, O.D.
• Robin Marie Henry, CFNP
• Stephanie Hensel, NP-C
• Christopher Henwood, LMSW
• Kurt Delmar Holiday
• Byron Ray Hollis
• Molly Hughes
• Huhukam Memorial Hospital Pharmacy
• Lisa Hussey, CDE

• General Practice Dentistry in Sacaton, AZ
• Providers in Sacaton, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.